@TumorBoardTues 1/17 #TumorBoardTuesday #LCSM #OncTwitter
50y 👩🏻 never 🚬 presents with cough

🩻CT: 2cm RLL 🫁 mass & pleural effusion
💧Tap of pleural fluid: adenocarcinoma TTF1+ (T1bN0M1a) Stage 4A #NSCLC
🧪NGS: exon19 deletion EGFR mutation & PDL1 70%+

🤨What’s most appropriate initial tx? @TumorBoardTues 2/17 #TumorBoardTuesday #LCSM

👩🏻 starts osimertinib with resolution of effusion

She has🧴dry skin & occasional 💩diarrhea managed with loperamide

After 18 months she develops headache
🧲MRI brain shows new 2cm 🧠 metastasis with edema

🤨What’s the most appropriate next step?

THREAD: I have heard a lot of self-righteous indignation about how we would be bankrupting the system with adjuvant targeted treatment for EGFR mutation+ NSCLC pts, so let's take a quick look at how many pts we're talking about here to put this in perspective. #ASCO20 #LCSM 1/8 There will be about 230,000 people diagnosed with lung cancer in the US in 2020, of which about 88% have NSCLC and 60% of those have adenocarcinoma (~121,000). About 15% of those have EGFR mutations, so the total # of EGFR mutation+ NSCLC cases in US in 2020 is about 18,000. 2/8

I messed up my poster so attaching slides here (Abstract 9529: A model comparing the value of broad next-gen sequencing (NGS)-based testing to single gene testing (SGT) in patients with nonsquamous non-small cell lung cancer (NSCLC) in the United States) #ASCO20 #LCSM 1/6 Although targeted treatments work well and we have 7 targets with FDA-approved drugs (EGFR/ALK/ROS1/BRAF/RET/MET/NTRK) testing levels are inadequate esp beyond EGFR/ALK, and many NSCLC who may benefit from tx pts die unidentified #ASCO20 #LCSM

THREAD: This post engendered a lot of strong reactions, mostly positive and some negative. GOOD. If you read this and felt angry for being "called out", at least it got you thinking which was my goal. I thought you might want to hear why this is important. /1

https://twitter.com/n8pennell/status/1019193813506711552

In the USA 75% of lung cancer patients over the age of 65 (i.e. most pts) get NO TREATMENT for their cancer (Davidoff, JCO 2010, 28; 2191-97). This is despite treatment being less toxic and prolonging survival in many. The reasons for this are many, but a big one is NIHILISM /2